From Euphoria to Pragmatism: The experience and potentials of ehealth in Asia Dr. Angelo Juan O. Ramos, MD, MPH Executive Director Molave Development Foundation, Inc.
"ehealth is the cost-effective and secure use of information and communications technologies in support of health and healthrelated fields, including health-care services, health surveillance, health literature, and health education, knowledge and research. - WHO
Can ehealth have a positive effect on health care delivery in developing countries? Can ehealth help ultimately reduce the global burden of disease?
ehealth can be good for Eliminating the impact of distance Reducing impact of time Increasing access (information, education, services) Standardizing processes (consistency, quality) Increasing equity
Why do we go for ehealth? Trends Needs-based Addressing existing issues and gaps Opening new avenues New demands on healthcare Managing costs Continuum of care Public Health Monitoring & Evaluation
ehealth & Components e-health Telehealth Use of ICTs to deliver health services, expertise and information over distance e-learning Delivery of individualized, comprehensive, dynamic learning content in real time, aiding the development of COPs, networking, and linking with experts. Health Informatics Deals with storage, retrieval and optimal use of biomedical data, information, and knowledge for problem solving and decision-making
Telehealth Remote consultation Referral systems Remote surgery Home, consumer-led telehealth
elearning Access to Sources of Knowledge Borderless Sharing of Resources Web-based Resources and Courses Video-conferences Meetings On-job trainings
Health Informatics HIS e-surveillance + Rapid Disease- Detection Systems Electronic Health Records Picture Archiving and Communication System (PACS) Knowledge management
Applications Store and forward EHR e-mail consultations + Telemonitoring e-learning Live videoconferencing Tele-consultations (Clinics) e-learning Supervisions Combination
Applications in Medicine Radiology Pathology Dermatology Obs & Gyn Surgery Medicine Psychiatry Community and Family Medicine Infectious Diseases
But there are still barriers! Organizational (culture, work flow) Human (lack of appropriate, skilled staff, resistance to change) Medico-legal, ethical
Continuing Digital Divide in Asia Cost of hardware and software Limited availability of fast broadband and mobile networks Slow development of software in languages other than English
Issues Sustainability Cost Turf issues Lack of interoperability Competing standards Cross-border issues Socio-cultural (i.e. gender, status) Ethical Resistance to change, perceptions Policy, governance gaps Expertise (ICT vs. health/medicine, brain drain)
Status of ehealth research in Asia Countries invovled in telehealth studies Systematic review (Durrani, et. al., 2008) Few papers done in Asia Others 29% Mixed countries 6% Japan 35% 109 papers from 1997-2008 Israel 6% South Korea 7% Hong kong 8% India 9%
Research Types and Quality Level Of Evidence Level I Type of Study Meta Analyses of RCTs Level II Large Sample RCTs 4 Number of studies - Good Strength of Evidence Level III Small Sample RCTs 4 Good to Level IV Prospective Studies 10 Fair Level V Retrospective Studies Level VI Cohort - Level VII Case Control 4 Level VIII Level IX Descriptive studies, NCCS Case reports or Anecdotes 4 44 Poor 39
Findings Studies that have emerged on telehealth applications are useful but lack good quality studies and in some cases the generalizability and scalability is limited to specific settings Gaps are there in form of Lack of evidence, readiness and policies Many studies did not demonstrate potential to scale up, and be sustainable
PANACeA -PAN Asian Collaboration for evidence-based e-health Adoption and Application
Projects Cost Benefit Analysis of available Hospital Information management system data mining and data warehousing Portable System for Telemedicine and Health Information in Rural and Remote Areas Remote Consultation to Improve Health Services for Rural Mothers Mainstreaming e-health initiatives in primary care: an evidence-based approach Leading Country Pakistan Malaysia Mongolia Philippines Other partners Thailand Philippines India Sri Lanka Bangladesh Philippines Nepal Philippines Pakistan India Real-time Biosurveillance Sri Lanka India Canada, USA Online TB Diagnostic Committees for Clinically Suspect Sputum Negative Patients in the TB- DOTS Program Disaster / Emergency Telemedicine System Use of Mobile Phone in Bridging the Gap for Referral of Pregnant Women Philippines Indonesia Philippines Pakistan India Thailand Philippines, India Pakistan Indonesia
PANACeA Research Issues Applications with the most beneficial outcomes on people s health and health systems Reaching populations without adequate access to health services Potential of using new pervasive technologies (mobile phones, PDAs etc.) and open source softwares Applications best suited to help prepare for, or mitigate the effects of, pandemics such as SARS and the Avian Flu?
Research Questions Which e-health applications and practices have had the most beneficial outcomes? What are the best ways for ensuring that beneficial outcomes can reach the population? What is the potential of using new pervasive technologies such as mobile phones / PDAs? What types of technologies / applications are best suited to help prepare for, or mitigate the effects of, disasters, pandemics and emerging and re-emerging diseases?
Being pragmatic lessons learned in the Philippines Start from where the people are. Identify appropriate, available, accessible and culturallyacceptable technologies. Embed the technology into the local fabric.
Final points Build capacity of health workers, students Integrate ehealth, Medical Informatics in the medical curriculum Talk with the ICT sector Be innovative Don t be tech crazy Go Free and Open Source!
The purpose of medicine is to prevent significant disease, to decrease pain and to postpone death... Technology has to support these goals-if not, it may even be counterproductive. Dr. Joel J.Nobel
ehealth is anything you want it to be! - Dr. Richard Scott
References Durrani, et. al. 2008. Does current evidence support use of telehealth in Asian countries? Results from Systematic Review. Canadian Society of Telehealth. Wootton, R., et.al. 2009. Telehealth in the Developing World. Royal Society of Medicine Press, London.
Thank You! Angelo Juan O. Ramos, MD, MPH Executive Director Molave Development Foundation, Inc. Makati City, Philippines ajoramos@molave.org